As is often the case with many diagnoses ending in “Syndrome,” Restless Legs Syndrome (RLS) can be elusive and challenging to diagnose, treat, and understand. While we sometimes work with patients who come to us primarily for help with RLS (yes, we do treat it), more often they are seeking treatment for some other problem and happen to mention they have RLS. In an effort to promote understanding of this condition, we have compiled this summary from the limited literature on RLS as well as our clinical experience.
What is RLS?
RLS is generally characterized by an urge to move and the feeling of unpleasant sensations inside the lower legs.1 Generally symptoms will affect both lower legs. Symptoms of RLS usually occur during periods of inactivity and resolve with movement or exercise. Typically at night time when attempting to rest is when symptoms are the worst, but problems can also be present during the day.
How is it Diagnosed?
As with many “syndromes,” there are no tests that absolutely confirm RLS. It is a diagnosis based purely on symptomology and the absence of other diagnoses that would account for the symptoms. The International Restless Legs Syndrome Study Group established criteria for diagnosis which include: a desire to move the limbs, usually associated with paraesthesia (pins and needles sensation) or dysaesthesia (abnormal sensation); motor restlessness; symptoms worse or exclusively present at rest; symptoms worse in the evening or night.2,3 Additional features that may accompany these signs or symptoms include: sleep disturbance, periodic limb movements in sleep, a normal neurological examination, chronic symptoms with exacerbations and remissions, and a positive family history.2 The establishment of such criteria indicate there are enough people with these complaints to justify studying them. However, establishing these criteria does not provide an explanation as to the cause or provide guidelines for treatment.
Why does it occur?
There are several unproven hypotheses attempting to explain RLS. The most common one cites iron deficiency, which can be identified with basic blood testing. But consider this: many people with iron deficiency do not have RLS, and many people with RLS do not exhibit iron deficiency. Then there are those with iron deficiency who still suffer with RLS even after their iron levels have been normalized. Certainly, normalizing iron levels in the body is desirable for many reasons. But logic dictates that this does not fully explain or address the problem for many individuals. If iron deficiency was the cause and the solution supplementation, then there would be no market for pharmaceuticals specifically targeting RLS. Yet the two most frequently prescribed medications, Pramipexole (Mirapex) and Ropinirole (Requip), are in high demand. Another proposed cause of RLS is dysfunction of dopamine (a neuro-transmitter affecting movement), although this also is unproven.
There is a growing body of literature and evidence supporting the phenomenon of myofascial trigger points, fascial densifications, and faulty movement patterns/habits as contributing to many neuro-musculo-skeletal dysfunctions. This is logical and believable when one considers the expansive network of muscle and fascia (connective tissue) throughout the body, and how tissue overload and trauma can lead to dysfunction. The symptoms of many of these disorders are similar to those associated with RLS. While at this time there are no studies proving a correlation, one must consider that there is no more evidence supporting iron deficiency as the primary cause of RLS.
How is RLS treated?
As discussed earlier, simple blood testing may identify iron deficiencies which should be addressed. More commonly, RLS is treated with medication as noted above.3 While these medications function to diminish the symptoms of RLS, they do not resolve any underlying cause. This necessitates long-term use, which can be expensive, and in 40% of users medications can cause undesirable side effects such as drowsiness, dizziness, and nausea. Other more severe symptoms can occur including cardiac arrest, delirium, and aneurysm although these are less common.
Currently there is very little research concerning the effectiveness of exercise on RLS. A small study that compared exercise (resistance and aerobic) to no intervention showed improvement in symptoms at 6 weeks and this improvement was maintained through 3 months (the length of the study).3 There has also been very limited research conducted to investigate the effectiveness of soft tissue techniques (massage, myofascial release) on symptoms, although case studies have shown promising results.4
It has been our clinical experience that addressing myofascial trigger points in muscles, densifications in fascia, and faulty movement patterns that overload soft tissues in the trunk and extremities can help to diminish/resolve the symptoms of RLS. Our evaluation emphasizing movement assessment and palpation typically exposes soft tissue movement restrictions and biomechanical movement dysfunctions in the legs and other areas of the body.5 Very often, patients suffering with RLS demonstrate fascial restrictions in the feet and pelvic regions, which makes sense if you consider that the legs are then caught in the middle of a connective tissue tug of war. Often (although not always) RLS patients have a history of dysfunction involving the feet such as heel pain/spurs, plantar fasciitis, and bunions. Some relate a history dating back to childhood, often sadly diagnosed as “growing pains.”
Effective interventions we often utilize include a combination of dry needling, Fascial Manipulation®, and exercise including Postural Restoration® techniques. These approaches are utilized wherever needed throughout the trunk and extremities, as a global total-body approach is typically most successful. Home exercises are essential for addressing strength and movement issues that cause overload and dysfunction to the soft tissues. Education as to faulty habits and postures perpetuating problems is also essential to resolving the symptoms.
Many people are unaware of the options available to them in the management and resolution of RLS. We hope that this information has been helpful for you, and strongly encourage anyone suffering with RLS to explore these options. For further information or to speak with one of our therapists please contact our office.
- Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of internal medicine, 266(5), 419-431.
- Chaudhuri, K. R., Appiah-Kubi, L. S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.
- Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. The Journal of the American Board of Family Medicine, 19(5), 487-493.
- Russell, M. (2007). Massage therapy and restless legs syndrome. Journal of Bodywork and Movement Therapies, 11(2), 146-150.
- Day, J. A., Copetti, L., & Rucli, G. (2012). From clinical experience to a model for the human fascial system. Journal of bodywork and movement therapies, 16(3), 372-380.
You spend an incredible amount of time using your feet every day, and if you are suffering from foot and ankle pain, your life can be greatly impacted. It can cause dread and agony when taking the stairs, walking a block to your office, or even driving your car. Foot and ankle pain can stem from a variety of different causes, but Appalachian Physical Therapy can help get you back on track. Physical therapy has been proven to help with the rehabilitation of injured extremities, in addition to providing relief for both acute and chronic pain. Contact Appalachian Physical Therapy today to speak with one of our licensed Harrisonburg, Broadway, and Pinehurst physical therapists and learn more about how our services can benefit you!
How does foot and ankle pain occur?
Your feet and your ankles are complex mechanical structures that must work together in harmony in order to function at their optimal levels. The Arthritis Foundation states that the ankle joint consists of three bones that all must interact with one another correctly, along with the various connective tissues that hold the assembly of the joint together.
The foot is even more complex, containing approximately two dozen bones, 30 joints, and over 100 muscles, tendons, and ligaments. Because of all the complicated structures that make up your feet and ankles, pain in those areas is a very common affliction. An injury to your foot or ankle can result in pain so severe that you avoid putting your weight down. This leaves you with only two options; hopping around, risking injury to your other foot, or worse, being stuck in a chair, unable to go anywhere and take care of yourself or others. Even mild pain can cause physical limitations to your daily life, and burden those around you.
What causes foot and ankle pain?
Foot and ankle pain can occur suddenly due to an acute injury, or it can develop over time in relation to a chronic, underlying condition. According to the Mayo Clinic, there are several common causes of foot pain and ankle pain, including:
- Strains and sprains. A strain occurs when a muscle or tendon is stretched, while a sprain occurs when a ligament is stretched too far or torn.
- Fractures. A fracture occurs from excessive force or trauma to the bone, causing it to crack or break entirely. A fracture to the foot or ankle could result in weeks of downtime to ensure proper healing.
- Tendinitis. Tendinitis occurs from excessive overuse of the tendons, causing them to become inflamed for a long time.
- Bursitis. Bursitis occurs when the tendons rub against the “bursae” or anti-friction sacs, causing them to become irritated and uncomfortable.
- Plantar fasciitis. Plantar fasciitis is an inflammation in the connective tissue on the bottom of your foot. This can occur from aggravated overuse, such as constant standing, improper posture, or footwear that lacks proper arch support.
- Tarsal tunnel syndrome. Tarsal tunnel syndrome occurs when the tarsal tunnel (the nerve that runs from the ankle to the foot) becomes pinched and inflamed.
- Arthritis. Arthritis is a common inflammatory condition that affects the joints and results in pain; the most common types including osteoarthritis and rheumatoid arthritis. Both types of arthritis can greatly impact the foot and ankle joints.
- Fallen arches. Your foot contains several tendons that work together to form your arch. When the tendons pull together properly, your foot will form a proper arch. However, when the tendons do not pull together properly, your foot will form a very small arch, or no arch at all. This is referred to as “fallen arch” or “flat foot” and can cause pain or discomfort with time.
How can physical therapy treat my foot and ankle pain?
Whether you are suffering from an acute injury or chronic condition in your foot or ankle, you can find relief at Appalachian Physical Therapy. Our Harrisonburg, Broadway, and Pinehurst physical therapists will conduct a thorough examination to confirm what is causing your pain, and then they will create a personalized treatment plan for you specifically. If you sustained an acute injury, it is likely that our physical therapists will prescribe a RICE treatment (rest, ice, compression, and elevation) for the first few days to make sure that any swelling decreases.
After the initial stages of your injury, you will move on to specialized physical therapy treatments. Comparatively, if you are suffering from a chronic condition, you will begin with specialized physical therapy treatments based on the needs of your condition. This is all part of your holistic healing or pain management program. The goal is to get you back to your normal level of physical performance and prevent future problems from occurring.
Your treatment plan will typically include a combination of exercises and stretching, in order to restore joint mobility, improve balance, and strengthen the foot and ankle muscles. Your treatment plan may also include exercises on a balance board, as well as other specialized services, such as ice and heat therapies, manual therapy, ultrasound, or cold laser therapy. We will do all we can to ease your pain and boost your circulation, which may include recommending lifestyle changes or orthotic footwear to prevent more problems in the future.
Don’t let foot and ankle pain slow you down! Our Harrisonburg, Broadway, and Pinehurst physical therapy practice will help you dictate your own mobility, comfort, and overall function, free from the limitations of pain. Contact Appalachian Physical Therapy today to schedule your screening. We’ll help you get back on your feet in no time!
For more information on Plantar Fasciitis Heel Pain, click here for our brochure.
Information coming soon!
What is Plantar Fasciitis?
Plantar fasciitis refers to inflammation of the plantar fascia, which is a thick band of tissue on the underside of the foot, connecting from the heel to the ball of the foot. Plantar fasciitis typically occurs from tightening of the tissues under the foot and even further up in the legs. In addition, changes in the shape of the foot, such as fallen arches or changes in shoe wear can affect plantar fasciitis. Furthermore, with changes in walking posture for a variety of reasons, the strain on the plantar fascia can increase significantly.
Plantar fasciitis is commonly felt as burning or sharp pain when standing on the affected leg. This typically occurs first thing in the morning or with initial standing after sitting for a prolonged period. Inflammation builds up during the day in the fascia, and may begin to hurt after prolonged walking. As you sit or sleep the inflammation thickens and the plantar fascia stiffens. When you go to step on the foot, the inflamed and stiff tissue stretches causing pain. Pain may be felt mostly in the heel, but can extend along the bottom of the foot.
How physical therapy helps
Physical therapy is very beneficial in treating plantar fasciitis. At first we evaluate your movement, posture, walking pattern, ankle and foot mobility. Our gentle hands-on therapy is great for soothing the irritated tissue in the foot and also improving range of motion in the foot and ankle joints.
Modalities, such as ultrasound and ice may be used to reduce swelling and pain quickly. Our goal is to reduce your pain quickly and strengthen your feet for long-term results. Call us today to discover how we can help resolve your plantar fasciitis pain and get you quickly back on your feet!
Information coming soon!
Information coming soon!
Information coming soon!
What is Sciatica?
Sciatica is the term used to describe radiating pain into the buttock that can travel down the back of the thigh. Often this pain is achy and spread out along these areas. Sciatica is a result of irritation to the sciatic nerve, which travels deep in the buttock and down the back of the leg. In about 20% of people, the sciatic nerve pierces through the piriformis muscle deep in the buttock instead of under it. This can make the sciatic nerve more susceptible to irritation and pressure from the piriformis muscle. The piriformis muscle helps guide hip movement, but can become very tight with prolonged sitting. This increased tightness causes pressure and irritation to the sciatic nerve causing pain.
What is Radiating Pain?
Radiating pain to the leg doesn’t necessarily mean you have sciatica, but it does tell you that something is wrong. Irritated muscles and tissue often can radiate pain. Spread-out, achy pain is often indicative of this type of problem. Sharp, stabbing pain with numbness or tingling is more nerve irritation or compression occurring in the low back or leg. These types of sensations typically occur to specific parts of the leg.
How physical therapy helps
Physical therapy is one of the best treatments for Sciatica and radiating pain into the leg. It first takes a thorough evaluation to determine where your problem is starting. Our physical therapists take time to examine the movement of your spine, hips and legs. Range of motion, strength, joint mobility and muscle condition are assessed by our physical therapists. After we determine the root cause of your problem, we put together a comprehensive plan to quickly relieve your pain, relieve your radiating symptoms, improve your range of motion, improve strength and help you to prevent future episodes.
With gentle, specialized hands-on techniques we work to improve your spinal and hip mobility, reducing pressure on your sciatic nerve. In addition, modalities such as heat, ice, electrical stimulation and ultrasound may be used to reduce inflammation and resolve your pain quickly. We then perform gentle stretching and strengthening exercises to restore your normal motion and strength. This results in lasting effects that will stop your pain from returning. Call us today to find out how we can relieve your Sciatica and radiating leg pain, returning you to the activities you love.
Lymphedema is a swelling that typically occurs in the upper or lower extremities, due to an excessive buildup of lymph fluid. Your lymphatic system is part of your circulatory system, and it is a network of vessels that carry lymph fluid towards the heart. The lymphatic system is an essential part of your immune and circulatory systems.
When a blockage happens in your lymphatic system, swelling of your arms or legs may occur, as the fluid is not able to drain properly. Improper drainage results in a build-up of the lymph fluid in your arms and legs, which can generate adverse health risks. If you are suffering from lymphedema, contact Appalachian Physical Therapy today to find relief!
How do I know if I have lymphedema?
There are two categories of lymphedema: primary lymphedema, meaning it occurs on its own, and secondary lymphedema, meaning it occurs as a result of an alternative disease or condition.
Lymphedema typically occurs as a result of surgical treatment involving the lymph nodes. It is most common in surgical cancer treatments where the lymph nodes are removed or damaged. However, the cause of primary lymphedema isn’t always clear, and your physician may want to take additional imaging tests in order to look at your lymphatic system. This may include an MRI scan, CT scan, Doppler ultrasound, or lymphoscintigraphy.
The most common causes of secondary lymphedema include:
- Radiation treatment for cancer
There are also a handful of symptoms that accompany lymphedema that could serve as indicators that you may have developed this condition. Keep in mind that it can sometimes take months or even years for lymphedema to develop as a result of cancer treatment.
Symptoms typically occur in the arms and legs, and they range from mild (noticing subtle changes or feelings in your limbs) to severe (noticing extreme changes or feelings in your limbs, to the point where they may be difficult to use).
Some common symptoms to look out for include, but are not limited to:
- Restricted range of motion
How is lymphedema treated?
With chronic swelling, there are many risks, including circulation issues, the risk of infection, and potential for future injury. It is very important to receive treatment for lymphedema and to follow up with your doctor and physical therapist on a routine basis.
At Appalachian Physical Therapy, we will design a personalized treatment plan to treat your lymphedema. This plan will be dependent upon your physical evaluation, health history, and the severity of your symptoms. For lymphatic treatment plans, the focus will be put strongly on manual therapy and light exercises.
A special type of manual therapy referred to as “manual lymph drainage” is commonly used for patients with lymphedema. It encourages the flow of lymph fluid in your upper and lower extremities, and additional massages may be used to increase circulation and provide relief.
Exercising the affected limb(s) also encourages lymph fluid drainage. Your exercise plan will be designed by one of our Harrisonburg, Broadway, and Pinehurst physical therapists and will involve gentle contractions of the muscles to regain function and improve your range of motion.
Additional treatments, such as wrapping, compression, or complete decongestive therapy may also be added to your treatment plan as our physical therapist deems fit. Contact our Harrisonburg, Broadway, and Pinehurst physical therapy office today if you are dealing with lymphedema and need some relief. Appalachian Physical Therapy will help reduce your lymphedema symptoms and improve your daily life. Your pain-free movement starts here!
Information coming soon!